Certainty of evidence from Cochrane Reviews on Neonatal Sepsis
Background: Neonatal sepsis is a modifiable risk factor for healthy growth and development during the neonatal period. More than one third of the estimated 4 million neonatal deaths around the world each year are caused by severe infections, and a quarter—approximately 1 million deaths—are due to neonatal sepsis/pneumonia alone. Neonatal infections and prematurity are currently the most challenging areas of research. Cochrane reviews provide the highest level of evidence on neonatal sepsis. Grading the quality of evidence in Cochrane reviews is applied to assess a wide range of interventions and contexts and is important to understand the impact evidence can generate.
Objectives: To assess the quality of evidence of Cochrane systematic reviews (SRs) on neonatal sepsis.
Methods: We searched the Cochrane library for SRs related to neonatal sepsis during a 2-year period (year 2020-2022) using the search term “neonatal sepsis.” We reviewed the certainty of evidence in these reviews.
Results: We retrieved five SRs in total. These SRs included three to five trials each, and the number of subjects included in the trials ranged from 482 to 1,103 in these reviews. The certainty of evidence was assessed to be of low to moderate quality (one SR), very low quality of evidence (three SRs), very low to moderate, and very low for all main outcomes (one SR). The reasons quoted for the low quality of evidence were small trial size (five SRs), methodological weaknesses (two SRs), high risk of bias (two SRs), imprecise results (one SR), low incidence of outcomes, and data not available for all outcomes (one SR). Evidence was downgraded by two to three levels in the five reviews.
Conclusions: Quality of evidence was assessed to be of low to very low quality in the Cochrane reviews on neonatal sepsis in the years 2020-2022. There is a need to initiate better-quality trials with adequate sample size (optimal information size). Certainty of evidence emanating from Cochrane reviews is important for guideline development and can affect clinical practice once included in guidelines.
Patient, public and/or healthcare consumer involvement: Good-quality evidence can directly impact clinical practice and improve treatment options for neonates in developing countries.